Symptoms:

Symptoms of heart failure often begin slowly. At first, they may only occur when you are very active. Over time, you may notice breathing problems and other symptoms even when you are resting.

Heart failure symptoms may also begin suddenly; for example, after a heart attack or other heart problem.

Common symptoms are:

• Cough
• Fatigue, weakness, faintness
• Loss of appetite
• Need to urinate at night
• Pulse that feels fast or irregular, or a sensation of feeling the heart beat (palpitations)
• Shortness of breath when you are active or after you lie down
• Swollen (enlarged) liver or abdomen
• Swollen feet and ankles
• Waking up from sleep after a couple of hours due to shortness of breath
• Weight gain

Signs and tests:

Your health care provider will examine you for signs of heart failure:

• Fast or difficult breathing
• Irregular or fast heartbeat and abnormal heart sounds
• Leg swelling (edema)
• Neck veins that stick out (are distended)
• Sounds ("crackles") from fluid buildup in your lungs, heard through a stethoscope
• Swelling of the liver or abdomen

An echocardiogram (echo) is often the best test to diagnose, learn the cause of, and monitor your heart failure. Your doctor will use it to guide your treatment.

Other imaging tests are:

• Cardiac stress tests
• Heart catheterization
• MRI of the heart
• Nuclear heart scans

Lab tests are done to help your doctor:

• Check how well your kidneys are working (BUN, creatinine, creatinine clearance, urinalysis)
• Look for a low blood count or anemia -- complete blood count (CBC)
• Test for brain natriuretic peptide (BNP)
• Watch sodium and potassium levels in your blood